Provider Demographics
NPI:1962402537
Name:BLUNK, JIM D (DO)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:D
Last Name:BLUNK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:620-845-2516
Mailing Address - Fax:620-845-2518
Practice Address - Street 1:415 S OSAGE ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-1650
Practice Address - Country:US
Practice Address - Phone:620-845-2516
Practice Address - Fax:620-845-2518
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2082207Q00000X
KS05-19457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100229560BMedicaid
OK100193490BMedicaid
KS100229560BMedicaid
OK100193490BMedicaid
OKP00627842Medicare PIN